ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1652742
This article is part of the Research TopicThe Role of Nutrition in Enhancing Surgical Recovery and OutcomesView all 5 articles
Geriatric nutritional risk index predicts perioperative cardiovascular events in older patients with coronary artery disease undergoing non-cardiac surgery: a multicenter retrospective cohort study
Provisionally accepted
- the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
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Background: The relationship between geriatric nutritional risk index (GNRI) and perioperative cardiovascular events (PCE) remains underexplored. This study aimed to evaluate the predictive utility of GNRI for PCEs in older patients with coronary artery disease (CAD) undergoing non-cardiac surgery. Methods: This multicenter retrospective study analyzed consecutive patients aged ≥ 65 years with documented CAD undergoing non-cardiac surgery between 2013 and 2024 at two Chinese tertiary medical centers. The primary outcome was a composite of PCEs, including death, resuscitated cardiac arrest, myocardial infarction, heart failure, and stroke, occurring intraoperatively or during postoperative hospitalization. Results: Among 7,272 participants, 408 (5.6%) experienced PCEs. GNRI exhibited a significant inverse linear correlation with PCEs (OR = 0.92; 95% CI: 0.91–0.93; p < 0.001). Using a GNRI cutoff of 98, the at-risk group (GNRI < 98) had a significantly higher incidence of PCEs compared to the no-risk group (GNRI ≥98) (univariate OR = 4.840; 95% CI: 3.947–5.935; p < 0.001; multivariate OR = 1.919; 95% CI: 1.496–2.461; p < 0.001). GNRI demonstrated comparable discriminatory ability to revised cardiac risk index (RCRI) (C-statistics: 0.676 vs. 0.694, p = 0.309). A weighted scoring system incorporating GNRI and RCRI significantly outperformed either index alone in predicting PCEs (vs. RCRI: C-statistics 0.768 vs. 0.694, p < 0.001; vs. GNRI: C-statistics 0.768 vs. 0.676, p < 0.001). Conclusions: GNRI independently predicted PCEs in older CAD patients undergoing non-cardiac surgery. Integrating GNRI into clinical decision-making may enhance perioperative risk stratification and management in this high-risk population, though further validation is warranted.
Keywords: Geriatric Nutritional Risk Index, perioperative cardiovascular events, Coronary Artery Disease, Non-cardiac surgery, Revised cardiac risk index
Received: 24 Jun 2025; Accepted: 26 Sep 2025.
Copyright: © 2025 Li, Wang, Jiang, Zhu, Wu, Niu, Chen and Jin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yunpeng Jin, 8013013@zju.edu.cn
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